Originally published 6/13/2019
It’s coming up on three years since we posted the blog below on the need for a doctor’s belief in the treatments he/she practices. As we noted, there was already an increase in the number of urologists who were coming to embrace focal therapy for prostate cancer (PCa). In Sep. 2021, the journal Urology Times featured an interview with Art Rastinehad, a Doctor of Osteopathic Medicine with a vibrant practice in urology. Osteopathic philosophy focuses on the whole person while treating an individual’s condition or disease. The commitment to healthcare-related quality of life is reflected in Dr. Rastinehad’s observation that with sophisticated diagnostics like multiparametric MRI and targeted biopsy, doctors can “better identify men that don’t have to have their prostate removed or radiated and help them avoid the risks of incontinence and erectile dysfunction.” Which brings us to Dr. Rastinehad’s point that the topic of focal therapy has “really exploded.” By implication, this means that in addition to acquiring the key skill sets that include tools from radiology, urology and oncology, a doctor needs to believe that focal therapy is not only a safe and appropriate treatment for the right patient, but also serves the whole person’s needs well on all levels. This conviction is a vital element in what qualifies a doctor to offer focal therapy.
Dr. Rastinehead identifies a number of factors that demonstrate how widely this conviction has grown: the 2019 birth of a Focal Therapy Society; an international data collection collaboration called The Focal Therapy Registry to track cancer control outcomes as well as quality of life metrics; the growing establishment of fellowships to train doctors in focal treatment; and the ever increasing number of clinical trials and studies of all the methods of targeting significant PCa tumors while sparing healthy tissues. While our own Center has been a pioneering leader in Focal Laser Ablation, we applaud the expanding community of physicians who wholeheartedly believe in focal therapy for the right patients.
“It is the repetition of affirmations that leads to belief. And once that belief becomes a deep conviction, things begin to happen.” Muhammad Ali
This is a blog about focal therapy for prostate cancer. More importantly, it is about the essential need for doctors to have a foundation of belief that supports focal therapy.
One of the ongoing themes in my blogs is the importance of matching a patient’s prostate cancer with the treatment for which he is best qualified. The lower the risk, the more treatment options will be open, possibly including focal therapy. However, “bulky” intermediate-to-high risk prostate cancer excludes focal treatment because it requires a more aggressive approach.
In looking for recent journal articles on focal therapy for prostate cancer, one title immediately stood out: Focal Ablation of Prostate Cancer.[i] It is a summary review on the current status of focal ablation. Topics include content I would expect: historical context; advances in screening, imaging, and diagnosis; patient selection; energies to deliver ablation, etc. But one topic seemed exceptional: “What you must believe.”
If you ask a patient what qualifies his doctor to offer, say, robotic prostatectomy, his answers might include things like
- Clinical and technical training
- Experience and practice
- Financial resources
- Access to appropriate equipment and devices, etc.
How often does it occur to the patient that the doctor must have the conviction and mindset that supports his or her confidence in the treatment? Don’t we all take that for granted?
Focal therapy: what must a doctor believe?
For any given therapy or treatment, the doctor who is delivering it must believe wholeheartedly in the treatment itself. I have had my own professional journey from curiosity and theory to deeply held belief that focal treatment – in particular, focal laser ablation (FLA) – is safe and effective for qualified patients. During all those years, I observed a growing shift in the field of urology away from cherished, time-honored beliefs. As research evidence accumulated, urologists were faced with new possibilities that challenged long-held assumptions. Three examples include:
- Prostate cancer is a multifocal disease.
- All prostate cancer, including Gleason 3+3, is life-threatening and must be treated aggressively.
- An elevated PSA requires immediate biopsy.
These and many other concepts often limited options offered by urologists to their patients.
Therefore, it came as a welcome
surprise to discover that the authors of the article (all affiliated with
the Department of Urology, NYU Langone Medical Center) identified five beliefs that qualify doctors to perform focal therapy, in addition to their clinical and technical skills. According to the authors, in order to treat prostate cancer focally, doctors must believe that
- Untreated insignificant PCa is of no immediate risk
- MRI identifies the index lesion
- MRI rarely fails to detect significant disease
- Ablation can be reliably delivered to pre-defined targets
- Preserving quality of life is a high priority for men with localized PCa.
Confidence in our beliefs
At the Sperling prostate center, we are proud to be in the vanguard of imaging and focal laser ablation. For years, our clinical work and patient services have demonstrated results that support those five beliefs. In conjunction with leading experts who are our global colleagues, we have made it our mission to ensure a sturdy belief platform of prostate cancer detection and diagnosis using multi-parametric MRI and MRI- guided FLA. It has indeed been our experience that when belief became a deep conviction, things truly happened.
This content is solely for purposes of information and does not substitute for
diagnostic or medical advice. Talk to your doctor if you are experiencing
pelvic pain, or have any other health concerns or questions of a personal
[i] Lepor H, Gold S, Wysock MD. Focal Ablation of Prostate CancerRev Urol. 2018; 20(4):145–157. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375006/